Only one out of five victims of sexual violence will receive the trauma counselling they are entitled to at a designated government hospital and clinic in South Africa, a new study by Doctors Without Borders (MSF) has found.
MSF estimates that half of these health facilities - mostly hospitals - don’t offer counselling services to child survivors of rape, who potentially represent up to half of all survivors.
The study evaluated 265 public facilities that provide medical and psychological care to survivors of sexual violence. Only half responded to the survey, and nearly a third of these declined to respond, saying they did not have permission from the Department of Health to participate.
A further 14% could not be reached because their telephone lines didn’t work, and another 14% delayed responding by asking to be called at another time - and ultimately, did not respond by the time the survey was completed.
Thuthuzela Care Centres, the government’s “one stop” rape care services, make up 55 of all these facilities.
Researchers conducted telephonic interviews during September and October, in which each facility was called at least five times.
A third of them have no counselling services for patients who have experienced sexual violence, according to the study, launched yesterday in Joburg.
Three quarters of the facilities don’t offer counselling services around the clock, says Yolanda Hanning, an MSF psychologist in North West province.
“The government’s response focuses overly on the medico-legal requirements for prosecution, and needs to more adequately address the holistic health needs of survivors,” said Hanning.
Constance Mlotshwa (not her real name) thought of killing herself after she was raped early this month. She went to a provincial hospital in North West to see a psychologist. Instead, she was made to sleep in a metal chair overnight while waiting for a bed.
“I thought if I can just gulp a box of rat poison I’ll go and everyone will be happy because I am broken and there is nothing anyone can do to help,” she told MSF.
Also earlier this month, President Cyril Ramaphosa announced at the Presidential Gender-Based Violence and Femicide Summit that the government would fund counselling services at Thuthuzela Care Centres if the need arose. For years, these facilities have been on the brink of shutting down due to a lack of funding.
“This is one of the biggest victories because the services for rape survivors that these organisations are providing are essential. At the moment we’re worried about what will happen to the centres because they’re not be able to do this on their own,” Sharon Kouta told Health-e News after Ramaphosa’s announcement.
Kouta is a gender-based violence specialist at the Networking HIV and Aids Community of Southern Africa.
There is little research on how sexual assault affects the mental health of survivors in South Africa. However, a 2015 survey conducted by MSF among 800 women between the ages of 18 and 49 in Rustenburg found a quarter had been raped in their lifetime.
In a third of cases of women who had a major depressive disorder, this could be attributed to rape and intimate partner violence.
Rape survivors are more likely to have depression or anxiety. A 2016 study in the Journal of Forensic and Legal Medicine found half of about 7400 rape survivors over the age of 16 in the UK suffered had anxiety, depression or other mental health issues.
Incidents such as Mlotshwa’s were far too common, said Hanning: “Depression and PTSD are common chronic mental health disorders faced by survivors of sexual violence.
“The lack of response to the basic human rights of mental health patients admitted to state hospitals continues to reflect the undermining of mental illness as a chronic condition that warrants an emergency response.”
Children who have been sexually violated face an even more dire situation. The report found there were no counselling services for children in almost half of the surveyed facilities.
About 60% did not have a “child-friendly space” with toys, a corner to play or equipment for play therapy.
More than a third (35%) of school children interviewed for a 2018 study in The Lancet reported they had been sexually abused at some point.
Together with the Department of Health, MSF runs four community health Kgomotso Care Centres that provide medical and psychological services to sexual violence survivors around Rustenburg. These are similar to the government’s one-stop rape services.
“After my rape I was thinking about suicide. I felt useless. I told myself these people destroyed me in and out, maybe if I go my gran will take care of my kids,” one woman told researchers.
“But since I’ve come here for counselling everything’s changed. I go to work every day, I smile with people, although it’s hard when I think about it. It’s very traumatising.”
Some 49% of facilities surveyed reported that counselling was done by a lay counsellor. Only a quarter were staffed with a registered counsellor.
As sexual violence often leads to serious psychiatric problems, such as PTSD or major depression, the study notes that it is unlikely a lay counsellor can adequately address them.
“From operational experience, we believe a registered counsellor is a more capable cadre when attending to the mental health needs of survivors who present at clinics,” says Dr Amir Shroufi, a medical co-ordinator for MSF in South Africa.
MSF is calling on the government to ensure that all 265 national facilities designated to provide emergency services for sexual violence victims are equipped to provide counselling services even outside working hours.
Hanning says: “This reality of erratic and unavailable services turns accessing mental health care into a lottery for survivors of sexual violence, one which can potentially lead to survivors taking their own lives.”